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This is a different sort of FFF Friday submission. Lynn wrote to me last spring, saying that she couldn’t bring herself to write out the entire tale of her infant feeding journey, but that she still wanted to share her story.

She felt the best way to do this was to submit the email she sent her husband, approximately three months after her son was born, three weeks after returning to full time work.

And you know what? This email told enough of the story. It told it all. Everything so many of us have felt, experienced, thought… all of it, laid bare, stripped down.

Happy Friday, fearless ones,

The FFF

***

Lynn’s Story

I suffer from depression and anxiety. The thought of postpartum depression scared the CRAP out of me, so much so that I wasn’t sure I wanted to bear a child (rather, adopt). I was advised early on in my pregnancy that I’d need to get at least six hours of sleep a night during those first six weeks. Little did I know, not only would that be nearly impossible, it would be absolutely crucial. Between a lactation consultant at the hospital thinking she observed my son having a seizure (which put us unnecessarily in NICU), and my son having a tough time staying latched, pumping ultimately became the most reasonable thing to do.

Two bouts of mastitis later…. this is the email I sent to my husband:

I can’t bring myself to say it out loud…

I can’t pump anymore.

I’m typing this in tears, shivering, with a 100.3 fever and an incredibly sore and tender boob. It’s nothing short of self-torture to keep doing this and maintaining a milk supply requires a shift in lifestyle that I obviously can’t maintain.

My therapist asked me to complete this sentence:

If I stopped pumping I would…

…go shout in the streets hallelujah.

This was not the response she expected.

She also asked, what would you tell yourself if you saw what you’re going through…

…stop.

I wish I weren’t the one pulling the plug (or, putting in the plug?). It is a smack-in-the-face reminder that I have to mother myself… which is just a Freudian nightmare in and of itself.

It’s fucked up, honey and not only can I not voice, I cannot type what I am truly, truly afraid of if I keep doing this to myself.

It’s been four years since you’ve had a newborn. Four years since you had to answer the inevitable are you nursing? questions, or had to buy a can of expensive hypoallergenic formula, or stare in envy at how easy it was for your friends to feed their babies. You’d sit there covered in renegade powder and splashed water, smelling like rotten potatoes; they’d push aside a designer nursing top and feed with ease. But you got through that hard first year. It was done. It was over.

But then, friends starting having more babies. Some were first timers, some were on number three. And though they may have struggled, all went on to join the sorority. You know the one: Alpha Lacta Nu. It’s a pretty easy sorority to join; the hazing involves some cracked nipples, a few hundred dollars in lactation consultant fees (at least pre-influx of Baby Friendly initiatives and ObamaCare), and a successful completion of Lactogenesis II. But for those who don’t pass the lactation equivalent of pledge week, it can feel like the most exclusive club in town. (Exclusive. Huh. Why does that ring a bell…?)

Beyond the politics of infant feeding, beyond guilt, beyond misleading articles, beyond the pressure to meet public health recommendations, lies something far simpler and emotionally loaded: it’s the feeling of being left out. Of not being allowed into the sisterhood. Of not being part of the real Club Motherhood, the one that shares inside jokes about drinking while nursing or recipes for lactation cookies.

Years go by, and the club opens up – now, your entry is based on toddler tantrums, preschool admissions, moving to neighborhoods “for the schools”. You find common ground. You start feeling like maybe motherhood is more than this, more than milk, more than nutrition, more mind than body.

But it’s always there – that little fizzle of ugly jealousy in your gut – and it will remind you of its presence when you see one of your own – one of the “uninitiated” – gain entry into the sorority with a second or third child. Suddenly, you’re left out again. One of your uncool friends just got invited to the cool kid’s table. She looks up, over her tuna fish sandwich, and shoots you an I’m-sorry-I’m-still-me-I-still-love-you-but-this-is-way-more-fun kind of half-smile. And the leggy blonde next to her, the one with the perfect teeth and 4.0 GPA, tosses her hair and you know, in that moment, that your friend is no longer like you. How can she be? She’s in.

And while you know – you know – that your lack of breastfeeding did nothing to your child’s health, or intelligence, or beauty; and you know – you know – that you are no less of a mother because of how you fed – that doesn’t stop the hurt. Because that’s not what it’s about. It’s not about guilt, or regret, or even jealousy of the nursing itself. You know you made the right choice for your and your family. It’s not about what people think it’s about.

It’s about wanting to be part of the club. Just for once. To not have to be the one people feel sorry for (oh, she couldn’t nurse, poor thing) or talk about (I bet she didn’t have enough support) or judge (I heard she could have if she’d just tried) or try and reassure (it’s okay! My aunt/sister/friend’s baby was formula fed and she’s just fine!) as they politely close the door to the sorority house in your face.

It’s about feeling happy and sad at the same time, when you see one of your own finally gain entry. You want her to be happy, to succeed at something that caused her pain and sadness the last time. But it’s also the loneliest feeling in the world to lose one of the only people who know what you know, and feel what you feel. You’re thrilled for her. And you also hate her, in the ugliest, tiniest, most disgusting part of your soul.

It’s about wishing for the day that motherhood won’t be measured in ounces produced, or tears shed, or bottles filled, but knowing that day probably won’t come, because it’s human nature, and we’re human.

It’s about reaching out, and wanting to start your own sorority – one that accepts you for who you are, and knows that your journey isn’t exactly like hers, and that’s okay – and finding more drama, more disagreement, and more ugliness.

It’s about realizing – finally, really realizing – that you’re not alone. That there’s community out there. That one day, this too really shall pass; that the majority of your close friends will leave the childbearing jungle years, and this sorority will cease to matter.

Someday, we will all graduate. I promise. And when that day comes, I’ll be the one waving my cap in the air, shouting hallelujah to the bigger, broader, world that’s waiting for us all.

My #ISupportYou partner, stomach Kim Simon, viagra 100mg and I have been working hard on developing a guide for bottle feeding support groups. In doing so, I’ve been pondering the reasons why we need such groups. After all, isn’t bottle feeding easy? Shouldn’t a decent handout on proper preparation and sterilization be sufficient for new formula feeding parents? There isn’t a learning curve like there is with breastfeeding; once you’ve got the hang of it, and have found a formula that works, you should be good to go.

Right?

This is what most of society believes, and it is so far from “right”. Maybe it is true for some families, but certainly not for the women who frequent FFF. True, the logistics of bottle feeding are pretty straightforward (although I personally believe troubleshooting is often needed, and resources for bottle issues are sorely lacking). But there is an emotional, psycho-social component to formula feeding that requires support and community.

If you don’t believe me, I urge you to read the story below. As Erin writes below, her experience with the shame of formula feeding “has been tremendously awful for the relationship I have with my baby. I started to pull away from him because it hurt so much to feel like I was harming him in some way. Everything about him reminds me of what wrong I think I’m inflicting.” How can we put so much pressure on women to nurse in the name of better bonding with their infants, when that same pressure is having the exact opposite effect on those who are unable or choose not to nurse? What would happen if, as bottle feeding parents, we had a place to come, to feel normal, to feel accepted, and to work through these conflicted emotions?

I want to create those spaces. Because I don’t want Erin and others like her to feel this way. It isn’t fair, it isn’t healthy, and it isn’t “right”.

Happy Friday, fearless ones,

The FFF

***

Erin’s Story

I had my first baby last month, after spending several weeks in the hospital with preeclampsia. When the preeclampsia became severe, I was given a c-section. My son was born at 35 weeks. The c-section did not go well–an insufficient amount of anesthesia was used, so that while I experienced some pain the muscles of my uterus did not relax, causing a half-hour struggle in the OR where a tech pushed at my belly and the OB tried to pull my baby out. Eventually they were forced to do more cutting in order to save his life.

As a preemie, he found it really hard to nurse, but I was determined. After my milk came in, I cup-fed him so that he would still be able to breastfeed. We had many visits by the lactation consultants. We were sent home with him nursing a little bit and supplemented by the cup. He was first introduced to formula when I was hospitalized again for an infection of my incision. As soon as I could, I was trying to nurse him again.

But it became clear after several weeks that it wasn’t really working. I had to nurse him for an hour, then feed him several ounces of pumped milk or formula, and then pump. It was the most exhausting ritual I’ve ever experienced, leaving no time for sleep. I paid for another visit with a lactation consultant, who found that he has a tongue and lip tie that prevents him from nursing successfully. We are now scheduled to have it removed, but for now he is being bottle fed, and it’s unlikely I will be able to nurse. In the post partum emotional rollercoaster, this is a punch to the gut. I have tried so hard. Seeing him refuse the breast (because he got nothing!) made me have crying jags for days.

What I’ve noticed is that this has been tremendously awful for the relationship I have with my baby. I started to pull away from him because it hurt so much to feel like I was harming him in some way. Everything about him reminds me of what wrong I think I’m inflicting. Seeing this happen, I know I had to give up the expectation of breastfeeding and not think about it. Otherwise he is going to have a depressed, withdrawn mother, which I’m sure will be much worse for him than any difference between methods of feeding. It’s just so hard to let it go. The cultural saturation of “breast is best” is really not helping. Everything I read online is disdainful of formula, even though many moms I’ve called, in tears, say they used it early or even exclusively. This needs to be an acknowledged reality so that when breastfeeding can’t happen moms don’t feel like they are harming their child, especially as it seems like a large number of women don’t breastfeed for whatever reason.

Reading other’s stories has helped. I am still crying a lot, and it still feels like this is something for which I must beg forgiveness. But my son is healthy so far, and I need to let this go.

It’s no secret that I’m a survivor of postpartum depression. It’s something I talk about a lot, and it informs everything I do with FFF. There is an obvious correlation between breastfeeding and postpartum mental health; whether this connection is positive or negative is a highly subjective, personal, individual matter. I see so many blanket statements, based on problematic data collection, and leaps of logic when it comes to this topic. No one ever stops to listen to the mothers who don’t fit their particular thesis. And while the topic of maternal mental health has slowly been gaining proper attention in both the media and research communities, as usual, the most important voices have been ignored: the voices of the mothers who have lived through PPD, and lived to tell the tale.

Thanks to Walker Karraa, PhD, these voices are now being heard. In her new book, Transformed by Postpartum Depression (Praeclarus Press, 2014) she reports on her own analysis and research as well as that of other pioneers/thought leaders in the maternal mental health field. But throughout, she allows the words of her subjects tell the story. And it’s an important story – one that not only highlights Karraa’s thesis, that PPD can be both traumatic and transformative, but also details how we are failing mothers at every turn. This is something that’s been discussed, even here on this blog, but Karraa’s delivery of the information is profoundly moving and startling because it is so specific, personal, and honest.

Using her interviews with 20 different women, all of whom survived moderate to severe PPD, Karraa examines the experience of postpartum depression. But this isn’t some clinical, cold volume that treats its subjects like research – the care and admiration Karraa has for her subjects is clear throughout the text. It’s a unique book; one that I believe will be just as helpful to moms as it is to mental health professionals and academics.

I think the FFF Friday series is powerful for many reasons, but the one that feels most vital to me is this: for every specific, personal story I share, there are hundreds of moms out there who see themselves in the words. These experiences are individual, but also collective, and sharing them helps both the writer (catharsis) and the reader (relief/camaradarie/normalization). Karraa’s book serves this purpose for the postpartum depression community. That would be enough – but she goes a step farther, pondering complex questions about how we approach the pathology of depression, and even analyzing her own reactions to her research. The result is something entirely unique, engaging, and important.

One section that deserves national attention – like, yesterday – is Karraa’s chapter on the failure of care providers to help these women. Her interviewees report harrowing tales of begging for help, only to be cruelly dismissed, ignored, or ridiculed. Nearly all reported a complete lack of forewarning that PPD was even a possibility, in prenatal classes and OB/GYN appointments – even when they had past histories of mental illness. Lactation consultants failed to see what breastfeeding was doing to a mother’s mental health; pediatricians told mothers their suicidal thoughts were “normal”; therapists refused to help or refer to others who could. These mothers were forced to take matters into their own hands, as Karraa describes:

As I analyzed this data, images of the walking wounded came to mind – as if these women were hemorrhaging – in public – and no one noticed… To walk through daily life dying and being ignored by care providers, and invisible to support systems was crazy-making and cruel. There was almost a punitive sense of the experience of care-provider failure – an additional layer of humiliation, indignity, and negligence…women got pragmatic; if their providers were not going to fix the problem, they would do it themselves.”

Of course, this could be viewed as a silver lining, in the American, pull-yourself-up-by-the-bootstraps sort of way. But that is not what Karraa is advocating. It’s inspiring to see how these women overcame adversity, but infuriating that they had to do it alone. I hope that this book will act as the missing link – a close-up on the face of postpartum depression, a healing volume for those who have been through this particular battle, and a call to action for our society to make immediate changes in how we approach postpartum mental health.

Lately, I’ve seen more discussion about the roles fathers (and partners) play in supporting breastfeeding. But I fear that there’s something missing in this discussion, a rather large elephant in the room that everyone is stubbornly ignoring despite the odor coming from the large pile of elephant dung in the corner.

Having a supportive partner is absolutely fantastic when you’re trying to breastfeed. But what does being supportive really mean? Does it mean being a breastfeeding cheerleader, reminding your partner of the benefits and imploring her to keep going? Or does it mean stepping in when you see her emotionally disintegrating before your eyes? How do we help our partners truly support us – by indoctrinating them on the importance of exclusive breastfeeding, or by educating them on postpartum mental health, and the importance of the emotional stability of the family?

My husband struggled with this. It’s something I’ve talked about before, but probably not to the extent that I should have. In our case, he took the breastfeeding classes and was entirely convinced that formula was NOT an option for our family. Plus, I’d told him I wanted to breastfeed. This meant that he believed his role was to keep reminding me of these things; every time I burst out in tears, wanting to quit, he’d say “this is what we decided” or “I have to think of FC, and what’s best for him.” As I was already halfway down the rabbit hole of PPD, these were not helpful statements. I resented him, and felt even more like a failure when things didn’t work out.

Six years later, Fearless Husband can’t even discuss what I do for a living. He’s still drowning in anger about it all; he feels like he was manipulated, which led him to put his wife’s emotional health (and his son’s physical health) at risk because of what society and the “experts” told him was absolute truth. I can look at my own experience with perspective; the passion I feel about this topic is no longer personal, but about feminism and justice and truth. For him, it’s still personal.

Our partners can be part of the solution, or part of the problem. They can’t win. They are doomed if they push us to keep going when we really need to stop, or if they push us to stop when we want to keep going; when they don’t have an opinion either way, or when they have too strong an opinion. So what can we do to help them help us?

I’d love to hear your ideas, and to collect them in a post that can be shared with concerned fathers and partners. Leave them in the comments below, or on the FFF Facebook page.

To start this conversation, I want to share a unique submission I received from Jeff, a father who is dealing with this exact Sophie’s choice of a situation. I am grateful to him for sharing his thoughts, and for supporting his wife in the best way he can.

Happy Friday, fearless ones,

The FFF

Jeff’s Story

We wanted to breast feed our baby for six months. We were committed to it. In fact, I was worried that as the dad, I wouldn’t have enough to do in the first months to care for our baby. And it hasn’t worked out that way…

I am completely fed up with what breastfeeding – exclusive pumping – is doing to my wife. Some background – our baby is 7 weeks old. We had a normal, uneventful delivery, and she’s healthy, gaining weight, and a perfect angel! But she just won’t latch. Let me tell you – we have tried. For hours, doggedly and desperately. Nipple shields, syringes and tubes, pillows, massage, hand expression, “lactation cookies”, lecithin, goat’s rue, countless cups of tea, rain dances and magic invocations… The few times she did latch, she did not get enough milk to satisfy her. After weight loss, dry diapers, and a lethargic baby, we started supplementing with formula. Our stress level went down, and our baby sprang to life!

We have seen four lactation consultants (two in the hospital, and two since we got home). They gave us terrific support – hours of individual attention and lots of moral support. They are wonderful, encouraging, and compassionate people – and I would not say we’ve felt bullied into breastfeeding. I’m very thankful to our insurance (Kaiser Permanente) for providing the support, because we didn’t want to give up. Our pediatrician and an ENT specialist checked for tongue-tie, and found nothing amiss. They also worked with us on the pump, so we’ve really given this an honest effort. We just don’t know where the issue is.

Both baby and mom have been in tears after attempt after attempt – robbing them of pleasurable bonding time. I’ve watched my wife in tears over the pain of engorgement and plugged ducts, a bout of mastitis, and the frustration and embarrassment of being hooked up to a pump while I get the pleasure of holding and feeding our baby. We haven’t had to supplement with formula much after the first week, but it’s come at a huge personal cost.

So, my wife became an exclusive pumper. Maybe our experience is atypical, but pumping takes forever. She spends close to an hour per session, many hours a day, just to keep abreast (pun intended) of the demand. It takes at least half an hour before she gets any flow. There simply are not enough hours in the day for her to pump, sleep, and hold the baby. So in the name of “breast is best”, our baby is being deprived of the comfort of her mother’s arms.

We blindly subscribed to the “breast is best” philosophy. Since these problems stated, however, I went back and read the primary literature on breast milk versus formula (I have a PhD in immunology, and my wife has a MPH and worked for the World Bank in the nutrition hub). I was surprised at how weak the evidence for breast milk over formula was! The most convincing evidence I can find is that breast milk protects babies from GI infections, which makes sense if you don’t have a clean water supply as a basis for your formula. That’s not a significant concern in the developed world, however. For nearly every study I read, the differences in IQ and every other measure are less than the test-to-test variation seen in individual children. (i.e., the difference seen between a breast fed and a formula fed baby is less than the difference seen if you tested the same baby twice.) Even if you believe those differences, the link between intelligence and breastfeeding is confounded by the many other variables that cluster with extended breast feeding, especially socioeconomic factors.

I’ve reached the conclusion that this is not serving my wife or our baby’s best interests. So, I am going to tell my wife tonight that I think she’s done a fantastic job giving our baby nothing but breast milk for the first 7 weeks, but that I am concerned that “extraction” of breast milk is dominating their relationship to the detriment of both of their health. I would rather see my daughter held in the arms of her happy mother drinking formula than look across the room at my wife’s teary eyes while I feed the baby breast milk sucked from her body.

I still support efforts to encourage breast feeding, but we have to be wise enough to recognize when it isn’t serving the best interests of the mother or baby. Public health recommendations are based on large groups of people – they cannot (nor do they try) to predict the best action for all people in all situations. If breastfeeding works for your family, that is wonderful and I’m genuinely happy for you. Please respect that it does not always work, despite desperate desires to the contrary. We didn’t want or choose this outcome, but I don’t feel bad for making a decision that protects my family’s physical and emotional health.

That’s why I think it’s time to support my wife and baby by suggesting she’s done enough, and that it’s time she put down the pump and picked up the baby.